Abstract:Objective To understand the change in distribution and antimicrobial resistance of bacteria isolated from blood specimens of Hunan Province, and provide for the initial diagnosis and treatment of clinical bloodstream infection (BSI). Methods Data reported from member units of Hunan Province Antimicrobial Resistance Survei-llance System from 2012 to 2021 were collected. Bacterial antimicrobial resistance surveillance method was implemented according to the technical scheme of China Antimicrobial Resistance Surveillance System (CARSS). Bacteria from blood specimens and bacterial antimicrobial susceptibility testing results were analyzed by WHONET 5.6 software and SPSS 27.0 software. Results A total of 207 054 bacterial strains were isolated from blood specimens from member units in Hunan Province Antimicrobial Resistance Surveillance System from 2012 to 2021, including 107 135 (51.7%) Gram-positive bacteria and 99 919 (48.3%) Gram-negative bacteria. There was no change in the top 6 pathogenic bacteria from 2012 to 2021, with Escherichia coli (n=51 537, 24.9%) ranking first, followed by Staphylococcus epidermidis (n=29 115, 14.1%), Staphylococcus aureus (n=17 402, 8.4%), Klebsiella pneumoniae (17 325, 8.4%), Pseudomonas aeruginosa (n=4 010, 1.9%) and Acinetobacter baumannii (n=3 598, 1.7%). The detection rate of methicillin-resistant Staphylococcus aureus (MRSA) decreased from 30.3% in 2015 to 20.7% in 2021, while the detection rate of methicillin-resistant coagulase-negative Staphylococcus (MRCNS) showed an upward trend year by year (57.9%-66.8%). No Staphylococcus was found to be resistant to vancomycin, linezolid, and teicoplanin. Among Gram-negative bacteria, constituent ratios of Escherichia coli and Klebsiella pneumoniae were 43.9%-53.9% and 14.2%-19.5%, respectively, both showing an upward trend (both P<0.001). Constituent ratios of Pseudomonas aeruginosa and Acinetobacter baumannii were 3.6%-5.1% and 3.0%-4.5%, respectively, both showing a downward trend year by year (both P<0.001). From 2012 to 2021, resistance rates of Escherichia coli to imipenem and ertapenem were 1.0%-2.0% and 0.6%-1.1%, respectively; presenting a downward trend (P＜0.001). The resistant rates of Klebsiella pneumoniae to meropenem and ertapenem were 7.4%-13.7% and 4.8%-6.4%, respectively, presenting a downward trend (both P<0.001). The resistance rates of Pseudomonas aeruginosa and Acinetobacter baumannii to carbapenem antibiotics were 7.1%-15.6% and 34.7%-45.7%, respectively. The trend of resistance to carbapenem antibiotics was relatively stable, but has decreased compared with 2012-2016. The resistance rates of Escherichia coli to the third-generation cephalosporins from 2012 to 2021 were 41.0%-65.4%, showing a downward trend year by year. Conclusion The constituent ratio of Gram-negative bacillus from blood specimens in Hunan Province has been increasing year by year, while the detection rate of carbapenem-resistant Gram-negative bacillus remained relatively stable in the past 5 years, and the detection rate of coagulase-negative Staphylococcus has shown a downward trend.

Abstract:Objective To investigate changes in the distribution and antimicrobial resistance of bacteria isolated from cerebrospinal fluid (CSF) specimens in Hunan Province, and provide reference for correct clinical diagnosis and rational antimicrobial use. Methods Data reported by member units of Hunan Province Antimicrobial Resistance Surveillance System from 2012 to 2021 were collected according to China Antimicrobial Resistance Surveillance System (CARSS) technical scheme. Data of bacteria isolated from CSF specimens and antimicrobial susceptibility testing results were analyzed with WHONET 5.6 and SPSS 20.0 software. Results A total of 11 837 bacterial strains were isolated from CSF specimens from member units of Hunan Province Antimicrobial Resistance Surveillance System from 2012 to 2021. The top 5 strains were coagulase-negative Staphylococcus (n=6 397, 54.0％), Acinetobacter baumannii (n=764, 6.5%), Staphylococcus aureus (n=606, 5.1％), Enterococcus faecium (n=465, 3.9%), and Escherichia coli (n=447, 3.8%). The detection rates of methicillin-resistant coagulase-negative Staphyloco-ccus (MRCNS) and methicillin-resistant Staphylococcus aureus (MRSA) were 58.9%-66.3% and 34.4%-62.1%, respectively. No Staphylococcus spp. were found to be resistant to vancomycin, linezolid, and teicoplanin. The detection rate of Enterococcus faecium was higher than that of Enterococcus faecalis, and the resistance rates of Enterococcus faecium to penicillin, ampicillin, high concentration streptomycin and levofloxacin were all higher than those of Enterococcus faecalis (all P=0.001). Resistance rate of Streptococcus pneumoniae to penicillin was 85.0%, at a high level. Resistance rate of Escherichia coli to ceftriaxone was >60%, while resistance rates to enzyme inhibitors and carbapenem antibiotics were low. Resistance rate of Klebsiella pneumoniae to ceftriaxone was >60%, to enzyme inhibitors piperacillin/tazobactam and cefoperazone/sulbactam was >30%, to carbapenem imipenem and me-ropenem was about 30%. Resistance rates of Acinetobacter baumannii to most tested antimicrobial agents were ＞60%, to imipenem and meropenem were 59.0%-79.4%, to polymyxin B was low. Conclusion Among the bacteria isolated from CSF specimens, coagulase-negative Staphylococcus accounts for the largest proportion, and the overall resistance of pathogenic bacteria is relatively serious. Bacterial antimicrobial resistance surveillance is very important for the effective treatment of central nerve system infection.

Abstract:Objective To investigate the distribution and antimicrobial susceptibility of clinically isolated bacteria from intensive care units (ICUs) in hospitals of Hunan Province Antimicrobial Resistance Surveillance System from 2012 to 2021. Methods According to China Antimicrobial Resistance Surveillance System, data of clinically isolated bacterial strains and antimicrobial susceptibility testing results of bacteria from ICUs reported by all member units of Hunan Province Antimicrobial Resistance Surveillance System were analyzed with WHONET 2022 software. Results From 2012 to 2021, the total number of bacteria isolated from ICUs of member units of the Hunan Province Antimicrobial Resistance Surveillance System was 5 777-22 369, with Gram-negative bacteria accounting for 76.1%-78.0% annually. Staphylococcus aureus ranked first among isolated Gram-positive bacteria each year. The top 5 bacteria among Gram-negative bacteria were Acinetobacter baumannii, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia. Detection rate of methicillin-resistant Staphylococcus aureus showed a downward trend year by year. No Staphylococcus spp. were found to be resistant to vancomycin, teicoplanin and linezolid. Detection rates of vancomycin-resistant Enterococcus faecalis and vancomycin-resistant Enterococcus faecium were 0.6-1.1% and 0.6%-2.2%, respectively. Resistance rates of Escherichia coli and Klebsiella pneumoniae to imipenem were 3.1%-5.7% and 7.7%-20.9%, respectively. Resistance rates of Pseudomonas aeruginosa and Acinetobacter baumannii to imipenem were 24.6%-40.1% and 76.1%-80.9%, respectively. Detection rates of carbapenem-resistant Pseudomonas aeruginosa declined year by year. Acinetobacter baumannii maintained high susceptibility to polymyxin B, with resistance rate ＜10%. Conclusion Antimicrobial resistance of bacteria from ICUs is serious. Carbapenem-resistant Enterobacteriales has an upward trend after 2019. It is nece-ssary to strengthen the surveillance of bacterial resistance and carry out multidisciplinary collaboration.

Abstract:Objective To understand the antimicrobial resistance of clinically isolated Enterococcus spp. in Hunan Province. Methods Surveillance data of Enterococcus spp. resistance from member units of Hunan Provincial Antimicrobial Resistance Surveillance System from 2012 to 2021 were collected. Data were cleaned according to a unified method, and WHONET 5.6 software was adopted for statistical analysis. Results From 2012 to 2021, a total of 110 652 non-repetitive Enterococcus spp. strains were included in the analysis, mainly Enterococcus faecalis and Enterococcus faecium, accounting for 46.9% (n=37 774) and 45.9% (n=36 968), respectively, followed by Enterococcus avium (2.5%, n=1 982), Enterococcus gallinarum (1.8%, n=1 428), and Enterococcus casseliflavus (1.5%, n=1 185). The main specimen sources of Enterococcus spp. was urine (51.8%, n=57 350), followed by secretions (9.6%, n=10 660) and bile (8.5%, n=9 377). From 2012 to 2021, the resistance rates of Enteroco-ccus faecalis to ampicillin, teicoplanin, and vancomycin were 5.5%-12.0%, 1.3%-2.0%, and 0.6%-1.4%, respectively. The resistance rates of Enterococcus faecium to ampicillin, teicoplanin, and vancomycin were 69.2%-85.0%, 1.5%-2.8%, and 0.7%-2.5%, respectively. Except for linezolid and minocycline, the resistance rates of Enterococcus faecium to tested antimicrobial agents were all higher than those of Enterococcus faecalis. The resistance rates of Enterococcus faecalis and Enterococcus faecium to vancomycin decreased from 1.4% and 2.1% in 2012 to 0.6% and 0.7% in 2021, respectively, presenting a decreased trend. Conclusion Clinically isolated Enterococcus spp. maintain high antimicrobial susceptibility to vancomycin and teicoplanin. Resistance rates of Enterococcus faecalis and Enterococcus faecium to vancomycin present decreased trends.

Abstract:Objective To analyze the distribution and changing trend of antimicrobial resistance of bacteria isolated from bile from Hunan Province Antimicrobial Resistance Surveillance System. Methods Data of pathogens isolated from bile from Hunan Province Antimicrobial Resistance Surveillance System from 2012 to 2021 were collected. The constituent of bacteria and antimicrobial susceptibility testing results were analyzed by WHONET 5.6 software. Changes in antimicrobial resistance was analyze by trend chi-square test. Results The major pathogenic bacteria isolated from bile were Gram-negative bacteria, accounting for 70.84%. The top three isolated Gram-negative pathogens were Escherichia coli (30.14%), Klebsiella pneumoniae(12.15%), and Pseudomonas aeruginosa(5.18%), and the top two Gram-positive bacteria were Enterococcus faecium (10.34%)and Enterococcus faecalis(9.52%). The resistance rates of Klebsiella pneumoniae and Escherichia coli to imipenem were highest in 2012-2013, being 15.7% and 14.9%, respectively, presenting an downward trend (P<0.05); resistance rates to piperacillin/tazobactam and cefoperazone/sulbactam were <24%, presenting an upward trend year by year (P<0.05); the susceptibility rate to amikacin was >94%, to levofloxacin and ciprofloxacin was 15.5%-65.2%. The highest resis-tance rate of Pseudomonas aeruginosa to imipenem (32.0%) was higher than that of meropenem (22.9%), resis-tance rates to piperacillin/tazobactam and cefoperazone/sulbactam were <19%. The highest resistance rates of Acinetobacter baumannii to imipenem and meropenem were 59.4% and 62.6%, respectively, resistance rate to cefo-perazone/sulbactam was <48%, presenting an upward trend (P<0.05); the highest resistance rate to ciprofloxacin (60.8%) was higher than levofloxacin (48.7%); resistance rate to tigecycline was <8%. The resistance rates of Enterococcus faecium to penicillin and ampicillin were both higher than those of Enterococcus faecalis, presenting an upward trend (P<0.05). Resistance rate of Enterococcus faecium to vancomycin was lower than that of Enterococcus faecalis. The resistance rates of Enterococcus faecium to vancomycin and linezolid were 0.5%-4.5% and 0.5%-3.4%, respectively; resistance rates of Enterococcus faecalis to vancomycin and linezolid were 0.2%-1.7% and 0.5%-3.5%, respectively (both P<0.05), all presenting a downward trend (all P<0.05). Conclusion Pathogenic bacteria isolated from bile are mainly related to the intestinal flora. The resistance rates of Enterococcus faecalis and Enterococcus faecium to vancomycin and linezolid as well as resistance rate of Enterobacterales to carbapenem antibiotics all present a downward trend.

Abstract:Objective To understand the antimicrobial resistance of Escherichia spp. from member units of Hunan Province Antimicrobial Resistance Surveillance System from 2012 to 2021. Methods According to the technical scheme of China Antimicrobial Resistance Surveillance System (CARSS), data about Escherichia spp. and the antimicrobial susceptibility testing results reported from member units of Hunan Province Antimicrobial Resistance Surveillance System were analyzed by WHONET 5.6 software. Results From 2012 to 2021, a total of 476 351 clinically isolated Escherichia spp. were collected, 475 520 of which were Escherichia coli, accounting for 99.8%; 92.6% were isolated from inpatients; 39.3% were isolated from urine specimens. Over the past 10 years, the proportion of Escherichia spp. in total detected pathogens remained relatively stable, ranging 20%-23%, the lowest rate was 18.7% in 2012, and the highest rate was 22.9% in 2015. In the past 10 years, the resistance rates of Escherichia spp. to ampicillin, ceftriaxone, cefotaxime and ampicillin/sulbactam were >80%, >47%, >45%, and >39%, respectively; resistance rates to piperacillin/tazobactam, cefoperazone/sulbactam, and nitrofurantoin were all <8%, to tigecycline, amikacin, imipenem, and meropenem (except in 2012) were all <5%. Resistance of Escherichia spp. to 22 commonly clinically used antimicrobial agents fluctuated, but overall trend decreased year by year. The resistance rates of Escherichia spp. from patients in the intensive care unit (ICU), non-ICU patients, outpatients, and emergency patients to 22 clinically commonly used antimicrobial agents were compared among different departments, and the differences were statistically significant (all P<0.05). The resistance rates of Escherichia spp. isolated from ICU and non-ICU patients were compared, and except for tigecycline, the resistance rates to the other 21 antimicrobial agents were statistically different (all P<0.05). The resistance rates of Escherichia spp. isolated from patients to commonly clinically used antimicrobial agents were statistically different among patients of different age groups (all P<0.05). Conclusion Escherichia spp. isolated from patients in different years, departments, specimens, and ages have different resistance to commonly used antimicrobial agents. It is necessary to continue to strengthen the surveillance on bacterial resistance, so as to guide the rational choice of antimicrobial agents.

Abstract:Objective To construct a risk prediction model for healthcare-associated infection (HAI) in stroke patients, accurately and effectively screen out potential high-risk groups, and formulate targeted preventive interventions to reduce the occurrence of infection. Methods Stroke patients in the "Henan Stroke Cohort" in 2019-2021 were selected as the study objects, and relevant clinical data were collected as the main analysis data for model construction and internal validation. The relevant data of stroke patients in three hospitals that had never participated in the cohort construction from January to September 2022 were randomly selected as a test set for external validation of the risk prediction model. The main analysis data were randomly divided into a training set and a test set, and a risk prediction model was constructed based on logistic regression, artificial neural network (ANN) algorithm, extreme gradient boosting algorithm and random forest algorithm, respectively. Multiple indicators were used to evaluate the prediction performance of the model, and the optimal model was externally validated based on the test set data. Results The infection rate of stroke patients was 20.6% in the main analysis data and 56.4% in the test set data. The accuracy of the risk prediction model based on logistic regression was 91.2%, the area under the receiver operating characteristic (ROC) curve (AUC) was 0.938, the precision rate, recall rate, specificity, and the F1 score were 0.851, 0.695, 0.968, and 0.765, respectively.The accuracy rate, precision rate, specificity and AUC of the logistic risk prediction model and the ANN risk prediction model were all significantly better than other models, while the recall rate and F1 score of the logistic risk prediction model were slightly better than the ANN risk prediction model. The logistic risk prediction model had excellent prediction performance in external validation. Conclusion HAI risk prediction model of stroke patients based on logistic regression can better screen out high-risk stroke patients with infection risk, and can contribute to formulate targeted preventive interventions to reduce the occurrence of infection.

Abstract:Objective To explore and evaluate the micro-elimination mode of hepatitis C virus (HCV) in patients in a general hospital in Jiangxi Province, and provide reference for formulating provincial strategies to eliminate the public health hazards of HCV. Methods Relevant data of hospitalized patients who received HCV screening at the hospital from January 2021 to December 2022 were collected. Data from 2021 were set as the baseline and data from 2022 as the HCV micro-elimination mode operating data. Indexes such as gender, age, department, anti-HCV positive rate, HCV-RNA positive rate, etc. were analyzed. The operational effect was analyzed based on specialty department visiting rate, treatment rate, and loss-to-follow-up (LTFU) rate. The development of the mode was quantitatively evaluated by superiority weakness opportunity threats-analytic hierarchy process (SWOT-AHP) method. Results A total of 397 744 hospitalized patients underwent anti-HCV screening from 2021 to 2022, with a male to female ratio of 1.34 ∶1 and an average age of 54 years old. The main departments for patients receiving screening were infectious diseases/gastroenterology departments. HCV gene subtypes in specimens from 62 patients was mainly subtype 1b (43 specimens), followed by subtype 6 (9 specimens). The first HCV early warning rate after mode operation was 81.20%, the anti-HCV detection rate after warning was 93.15%, and the anti-HCV detection rate after subsequent pop-up window early warning was 100%. Compared with 2021, the treatment rate of HCV hospitalized patients in 2022 has increased, with statistically significant difference (P<0.05). However, there were no statistically significant differences in patients’ specialty department visiting rate and LTFU rate (both P>0.05). Barycentric coordinates calculation P (X, Y)=(0.018 2, 0.006 9) located in the first quadrant. Conclusion The HCV micro-elimination mode for patients in a general hospital in Jiangxi Province is feasible and effective. Further mode optimization should focus on strengths/opportunities (SO) strategy, to rely on internal advantages and utilize external opportunities.

Abstract:Objective To observe and compare the changes of vertebral bone mineral density (BMD) in the early stages of spinal Mycobacterium tuberculosis infection. Methods Patients who underwent spinal surgery at Xiangya Hospital, Central South University from January 1 to December 31, 2023 were continuously enrolled (spinal tuberculosis group), based on gender matching, non-spinal tuberculosis surgical patients treated for spinal stenosis were selected as the control group. Dual-energy X-ray scans were performed on the enrolled patients, difference in vertebral BMD between two groups of patients was compared. An animal model of spinal Mycobacterium tuberculosis infection (referred to as the animal model) was constructed, differences in microstructure of trabecular bone between spinal tuberculosis group and control group was compared, and the bone volume/tissue volume (BV/TV), the thickness of trabecular bone (Tb.Th), the number of trabecular bone (Tb.N), and sparse density of trabecular (Tb.Sp) were used as evaluation indexes to further analyze the bone quality differences between the diseased vertebrae and the neighboring vertebrae. Results 69 patients were included in the spinal tuberculosis group and the control group, respectively. The BMD of patients in the spinal tuberculosis group (0.793 ［0.712, 0.869］ g/cm²) was lower than that of the control group (0.907 ［0.800, 1.020］ g/cm²), difference was statistically significant (P<0.05). Microstructure of trabecular bone BV/TV (［18.4±5.4］%), Tb.Th (［0.124±0.010］ mm) in the spinal tuberculosis group of animal model were significantly altered compared with BV/TV (［22.6±3.2］%), Tb.Th (［0.160±0.017］ mm) in the control group (both P<0.05). In the spinal tuberculosis group, microstructure of diseased vetebral trabecular bone BV/TV (［25.5±6.7］%) and Tb.N (［1.871±0.443］/mm) were significantly lower than BV/TV (［26.6±6.8］%) and Tb.N (［1.969±0.454］/mm) in the neighboring vertebrae, both with statistically difference (both P<0.05). Conclusion In the early stages of spinal Mycobacterium tuberculosis infection, microstructure of vertebral trabecular bone can be altered, leading to a decrease in BMD.

Abstract:Objective To analyze the epidemiological and clinical characteristics of patients with monkeypox. Methods Data of 17 patients with monkeypox hospitalized in a hospital in Nanning City from July to October 2023 were collected retrospectively. The epidemiological history, clinical manifestations, laboratory examinations, treatment and prognosis were analyzed and summarized. Results All 17 patients were male, with a median age of 28 years old. Fifteen (88.2%) patients were men who had sex with men (MSM) within 21 days prior to onset. Major clinical manifestations were rash and fever. Rashes distributed mainly in the anus, perineum and genitals (82.4%), followed by the trunk and limbs (52.9%), head and face (35.3%), while soles and palms were rare. Some patients had swollen inguinal lymph nodes. All patients were discharged from hospital after improvement, with an average hospital stay of 7 days. Conclusion The monkeypox epidemic in Nanning area of Guangxi occurs mainly in MSM population, with fever and rashes as the major symptoms. All patients have mild disease and good prognosis.

Abstract:Objective To explore the disinfection effect of ozone combined with peracetic acid (PAA) on reducing the total number of aerobic bacteria in pure water from the terminal of centralized pure water supply system. Methods A two-stage controlled study was conducted, and microbial limit test was performed on the pure water from the terminal of centralized pure water supply system in a hospital. At the first stage, PAA disinfection method was adop-ted, and ozone enhanced disinfection (PAA combined with ozone disinfection) was adopted at the second stage. Disinfection effects at different stages were compared. Results A total of 211 water specimens were collected for testing, including 101 specimens from PAA disinfection group and 110 from ozone enhanced disinfection group. The bacterial colony qualification rate of terminal pure water from the ozone enhanced disinfection group was higher than PAA group ( 85.45% vs 74.26%, P=0.04). The median of aerobic bacterial colony number of the ozone enhanced disinfection group (2 CFU/mL) was significantly lower than that of the PAA disinfection group (20 CFU/mL). With time increase after disinfection, the number of aerobic bacteria colony in water specimens from the PAA disinfection group showed a significant upward trend (Day 1 vs Day 92: 9 CFU/mL vs 1 062 CFU/mL), while the aerobic bacteria fluctuation range in the pure water from the ozone enhanced disinfection group was relatively small (Day 1 vs Day 92: 8 CFU/mL vs 58 CFU/mL). Conclusion The ozone combined with PAA disinfection method can significantly reduce the total number of aerobic bacteria in water from the terminal of centralized pure water supply system, with obvious maintaining effect.

Abstract:Objective To understand the disease acceptance status and related factors in human immunodeficiency virus (HIV)-infected/acquired immunodeficiency syndrom (AIDS) patients, so as to guide the clinical development of intervention measures, and to provide empirical evidence for improving clinical outcomes. Methods Convenience sampling method was used to select 555 HIV-infected/AIDS patients who received treatment in the designated AIDS treatment clinic of a hospital. General data, disease acceptance, disease self-management efficacy and clinical outcomes (such as quality of life, CD4⁺T lymphocyte count and HIV viral load) of the studied subjects were collected. Results The average disease acceptance of HIV-infected/AIDS patients was (26.08±5.34) points. Multiple linear regression analysis showed that religious belief and self-management efficacy were related factors affecting the di-sease acceptance of patients (both P<0.05), which could explain the 30.4% variation in disease acceptance of HIV-infected/AIDS patients, and the disease acceptance of patients was closely related to their quality of life (P<0.001). Conclusion HIV-infected/AIDS patients have a moderate level of disease acceptance. Medical staff should fully consider patients’ religious beliefs and self-management efficacy, so as to formulate targeted intervention mea-sures to improve patients’ acceptance of disease, and further promote patients’ quality of life.

Abstract:Objective To construct an index system of clinicians’ ability to cope with outburst respiratory infectious diseases, and provide a framework for developing corresponding training programs. Methods Based on literature analysis and theoretical research, the first draft of competency index system was constructed, 2 rounds of consultation to 23 experts were conducted using Delphi method, and the index weights were calculated by analytic hie-rarchy process. Results The effective recovery rate of correspondence questionnaire in 2 rounds of expert consultation was 100%, and the expert authority coefficients of the first and second rounds were 0.81 and 0.84, respectively. Kendall’s coefficient of concordant was 0.110-0.350, with statistical significance (all P<0.01). After two rounds of expert consultation, an index system of clinicians’ ability to cope with outburst respiratory infectious di-seases has been formed, including 3 first-level indexes, 17 second-level indexes and 49 third-level indexes. Conclusion This index system not only can be used to evaluate clinicians’ ability to cope with outburst respiratory infectious di-seases, but also can be used as content framework for the training program of clinicians’ ability to cope with respiratory infectious diseases.

Abstract:Objective To investigate the causes of a cluster of suspected neonatal carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infection (BSI) in the neonatal department of a hospital, and provide references for the effective control of the occurrence of healthcare-associated infection (HAI). Methods Epidemiological investigation on 3 neonates with CRKP BSI in the neonatal department from January 31 to February 6, 2023 was performed. Specimens from environmental object surfaces were taken for environmental hygiene monitoring, and effective control measures were taken according to the risk factors. Results From January 31 to February 6, 2023, a total of 60 neonates were admitted in the neonatal department, including 16 with peripherally inserted central venous catheter (PICC). Three neonates had CRKP BSI, with a incidence of 5.00%. There were 33 hospitalized neonates on the day (February 7) when the cluster of HAI was reported, with a prevalence rate of 9.09% (3/33). CRKP BSI rate in the neonatal department of this hospital from January 31 to February 6, 2023 was higher than that in 2022 (P<0.001). The incubators of the 3 neonates with CRKP BSI were in the same ward and adjacent to each other. The first neonate with CRKP BSI (who developed BSI on January 31) underwent PICC maintenance on February 4, and the other 2 neonates with PICC maintenance immediately following the first one also developed CRKP BSI. CRKP were isolated from blood culture of all 3 neonates, and antimicrobial susceptibility testing results were consistent. Conclusion The occurrence of the cluster event of neonatal CRKP BSI may be related to the failure of strict implementation of aseptic procedures during PICC maintenance and cross contamination among items.

Abstract:Ichthyosis is a hereditary dyskeratotic skin disease with systemic skin dryness and roughness, mainly manifested by scaly skin, which may be accompanied by ocular abnormalities. At present, there are many studies on skin fungal infection caused by ichthyosis, but only few reports on cases with combined ocular fungal infection. This paper reports a case of X-linked recessive hereditary ichthyosis with recurrent fungal keratitis (FK), which is expected to provide reference for clinical early diagnosis and treatment of this disease.

Abstract:One patient was admitted to a hospital due to "sepsis, chronic kidney disease, type 2 diabetes, shock, and cerebral infarction". Patient’s blood specimen was taken for clinical examination. Aerobic and anaerobic culture results of catheter blood and venous blood were both positive. The pathogen was identified as Staphylococcus pasteuri by VITEK MS, and the patient was diagnosed as catheter-related bloodstream infection caused by Staphylococcus pasteuri. Clinical empirical use of piperacillin for anti-infection treatment was ineffective, and vancomycin was eventually used for treatment based on in vitro antimicrobial susceptibility testing. Patient’s condition improved after removing the venous catheter. There are currently no reported cases of Staphylococcus pasteuri in China. Early identification of pathogen and adjustment of treatment plans based on antimicrobial susceptibility testing results are crucial for effective treatment of this case.

Abstract:

Abstract:In recent years, the prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection has become a global public health issue. Ceftazidime/avibactam (CAZ/AVI) has been approved as a novel antimicrobial agent for the treatment of healthcare-associated pneumonia/ventilator-associated pneumonia, bloodstream infection, infection after kidney transplantation, and severe infection combined with liver cirrhosis. However, the use of CAZ/AVI has also led to the emergence of drug-resistant strains. The major mechanisms of drug-resistance include over-expression of bla_KPC gene, mutation of β-lactamase and amino acids at key sites, changes in cell permeability caused by loss of membrane porin, and over-expression of efflux pump. This article reviews the research progress of CAZ/AVI in the treatment of CRKP infection, providing reference for clinical diagnosis and treatment.

Abstract:Hospital water supply system may serve as a reservoir of waterborne pathogens, and contaminated water can lead to the occurrence and outbreak of healthcare-associated infection (HAI), which bring great challenge to the prevention and control of HAI. Waterborne pathogens, such as Pseudomonas aeruginosa, Legionella, no-tuberculous Mycobacterium, Acinetobacter, and Stenotrophomonas maltophilia, often propagate and spread through the water supply system. Water temperature, residual chlorine concentration, and biofilm in water supply system are key influencing factors. This article reviews the current situation of waterborne infection, characteristics and influencing factors of water supply system in medical institutions in recent years, as well as related waterborne infection events at home and abroad, so as to bring new insights for the prevention and control of waterborne infection in medical institutions.